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Here’s a potential snag in the success of health reform: Almost two-thirds of uninsured Americans haven’t yet decided whether they will purchase health insurance by the Jan. 1 deadline.

That’s the finding from InsuranceQuotes.com, which surveyed some 1,000 Americans.

What's behind the indecision? Most uninsureds don’t think the Patient Protection and Affordable Care Act will make health care any more affordable. More than three in five uninsured Americans say the main reason they currently lack health insurance today is because they can’t afford it.

And that’s a fear among the majority of all Americans, the survey found. Most, 61 percent, say they’re concerned that PPACA will cause health care costs to increase, while only 26 percent predict a decrease.

There's good reason for concern. A recent report from Milliman consulting firm found that health insurance premiums, on average, could rise by 40 percent under PPACA.

The success of the PPACA mainly relies on uninsured Americans buying into a plan. Beginning Jan. 1, uninsured Americans will be forced to pay a penalty of either $95 or 1 percent of income, whichever is greater, if they don't buy insurance. The fine increases with each year.

Without participation, experts warn health care costs may surge because not enough healthy people will participate to offset benefits payouts.
Only 19 percent of the uninsured surveyed by InsuranceQuotes.com said they will get coverage by the deadline, while 10 percent said they plan to stay uninsured and pay the penalty. The rest haven’t decided, despite the fact that open enrollment under state exchanges that are selling coverage is set to begin in a few months.

The new survey also found widespread confusion — and skepticism — about the law’s provisions. Most of those questioned (58 percent) said they aren’t sure whether they are eligible for the law’s health subsidies. And those with an annual income under $30,000 are the least likely to be aware of their eligibility (68 percent aren’t sure).

Laura Adams, senior insurance analyst for InsuranceQuotes.com, said the number of Americans still unsure of how PPACA will affect them is “shocking.”